Healthcare Provider Details

I. General information

NPI: 1770997959
Provider Name (Legal Business Name): DAVID GEVORGYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 02/15/2022
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

747 BROADWAY
SEATTLE WA
98122-4379
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2202
  • Fax: 206-386-6612
Mailing address:
  • Phone: 206-386-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60755886
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: